Conception

Hysterosalpingography: everything you need to know

What is hysterosalpingography for and how is it performed? Is it painful? Here’s everything you need to know about this exam, including preparation, cost, and popular alternatives.

Hysterosalpingography (also called uterosalpingography or, improperly, tubal examination) is a radiographic investigation that is used to evaluate the female reproductive system.

Generally, hysterosalpingography is among the tests prescribed when the woman is suspected of infertility .

Today, however, it is a rarely used test, typically being replaced by sonohysterosalpingography .

What can be seen with hysterosalpingography?

This exam allows you to:

  • check the shape and size of the uterus , highlighting any changes;
  • analyze the fallopian tubes (also called salpingi ), to verify that they are not partially or completely blocked;
  • evaluate the  tubal motility (ie the ability of the tubes to make the mature egg progress inside them, so that it can “meet” any sperm).

Hysterosalpingography therefore represents an important examination to discover and eliminate some possible causes of infertility .

The presence of anomalies in the shape of the uterus , closed tubes or an alteration of the tubal motility, in fact, can hinder the search for a pregnancy.

Hysterosalpingography: when to do it?

Usually, the exam is performed in the first half of the menstrual cycle, i.e. at the end of the flow but before ovulation , to minimize the possibility that a pregnancy may be in progress.

In particular, it is performed in the week following the end of the menstrual flow (between the 5th and 13th day of the cycle).

It is important to underline that hysterosalpingography cannot be performed if the woman is pregnant , because it would cause an abortion .

How is hysterosalpingography performed?

Hysterosalpingography is an outpatient procedure that does not require anesthesia .

The examination is carried out by injecting iodinated contrast medium (ie a sort of “dye” visible in radiography and based on iodine) into the uterine cavity through a thin catheter.

This material slowly fills the uterine cavity and fallopian tubes, and if these are patent (ie unobstructed) it passes into the peritoneal cavity.

Several radiographs are also taken during the injection , to document the path of the contrast medium.

The injected fluid allows the shape of the uterus and the patency or otherwise of the salpinges to be viewed on the x-rays. If the tubes are patent, they become opaque and the contrast passes into the peritoneal cavity, where it is dispersed, allowing the position of the salpinges to be evaluated .

As can be understood, hysterosalpingography is an exam to be used sparingly, as the woman is subjected to radiation which involves the genital system and therefore the oocytes. Also for this reason, there is an increasing tendency to replace it with sonohysterosalpingography.

How long does hysterosalpingography take?

In all, the exam lasts approximately 20-30 minutes .

Exam preparation

To do this analysis it is not necessary to fast.

Instead, it is important to avoid having unprotected sex from the start date of the
last period until after the exam
 , in order not to run the risk of becoming pregnant during the procedure.

Your doctor may recommend performing an enema or taking a laxative the night before , to empty your bowels and better visualize the structures to be examined.

They may also recommend a pain reliever (ibuprofen) or antispasmodic about an hour before the procedure to reduce discomfort and relax your muscles.

Finally, in some cases, an antibiotic may also be prescribed , to be started the day before the exam, to reduce the risk of infections.

Usually,  each center delivers the instructions to follow in order to prepare for the exam in the best possible way . In any case, if in any doubt, speak to your trusted doctor.

One last piece of advice: if possible, it’s preferable to be accompanied to your appointment so you don’t have to drive back.

during the procedure

The doctor will ask you to lie down on the couch and rest your legs on the side supports, as in a normal gynecological visit.

She will initially do a quick pelvic exam and then insert a small instrument inside your vagina, called a speculum , to keep it open. This device is the same that is used during the annual gynecological checkups.

At this point, he will position the X-ray device used for this procedure, which is called a fluoroscope. In addition, a swab will be inserted into the vagina to disinfect the cervix and reduce the risk of infection . If the area is very sensitive to touch, this procedure may be a little uncomfortable, but most women feel no pain at all.

Next, your doctor will insert a small catheter into your cervical opening. The sensation should be similar to that of a regular pap smear.

Finally, he will inject the contrast medium through the catheter. During this stage, you may feel a warm sensation.

While taking x-rays, your doctor may ask you to change your position, such as turning onto your side.

Is hysterosalpingography painful?

The first concern of those who have to undergo this procedure is that it can be very painful. “Does hysterosalpingography hurt?” is in fact one of the most frequent questions that women ask on the web regarding this exam.

If you are looking for a comparison with those who have already been through it, in our forum you can read the  experiences and testimonials of those who have done it .

As you will see, the answer to this question varies from woman to woman. Some felt nothing, others report having mild or moderate cramps , still others more intense pain . Many say the fear before the exam was worse than the procedure itself.

In general, we can say that hysterosalpingography involves some  discomfort , which varies according to the personal sensitivity and skill of the operator . In addition, anxiety and fear can increase the perception of pain.

The discomfort is felt especially during the insertion of the catheter and the introduction of the contrast medium, which can cause a slight distention of the uterus and a sensation of cramps or light pain, similar to that of the menstrual cycle . The discomfort may persist for some time, even after the exam is over.

If the tubes are blocked , however, the contrast may cause pressure to build up in the tubes and make the discomfort worse.

In case of intense pain, it is important to inform the doctor: in fact, by removing the catheter, there will be a decrease in pressure and the disappearance of the painful sensation.

After the exam

In addition to the sensation of menstrual-like cramps in the abdomen, which can possibly be reduced by taking a painkiller, it may happen that you observe light bleeding (for about 2-3 days) or sticky vaginal discharge (due to the contrast medium ).

Other side effects may be weakness , dizziness or stomach discomfort .

How long to wait to have intercourse after hysterosalpingography?

To find out when you can start having intercourse again, it is a good idea to ask your doctor .

In fact, while for some specialists it is possible to start the search for pregnancy as early as the same month as the examination (modern machinery has allowed a considerable reduction in the amount of radiation emitted), for the majority it would be preferable to wait at least 2-3 months  , for ” dispose of” the absorbed radiations .

Hysterosalpingography: the risks

Hysterosalpingography is a relatively safe procedure , but like all medical interventions it can have risks.

In rare cases, for example, an allergic reaction to the contrast medium or a pelvic infection could occur . 

In general, it is important to always see your doctor if you experience any of the following signs or symptoms after the test:

  • foul-smelling vaginal discharge
  • vomit
  • fainting
  • severe abdominal pain
  • heavy vaginal bleeding
  • fever or chills

Hysterosalpingography: the results

If the result is positive

When the exam shows the presence of blockage of the tubes or abnormalities of the uterus, the doctor may recommend other in-depth tests , to evaluate the most suitable treatment for the individual situation. In some cases, he may suggest using assisted reproduction techniques.

Importantly, hysterosalpingography has a 15% “false positive” rate . This means that in some cases it can signal a non-existent blockage of the tubes, at the point where they join the uterus. When this happens, your doctor may request a retest or order a different test .

If the result is negative

If the test shows no tubal or uterine abnormalities, further investigation may still be needed.

In fact, hysterosalpingography does not allow to detect any type of problem related to conception. Diagnosing hormonal infertility or endometriosis, for example, requires different tests.

In addition, there is a 35% “false negative” rate , in which the test fails to detect abnormalities of the uterus, which instead appear visible via hysteroscopy. 

How much does hysterosalpingography cost?

If performed with a prescription through the National Health Service, the cost of hysterosalpingography is that of the ticket .

Privately , the price can vary from 200 to 500 euros .

Pregnancy rate after hysterosalpingography

This type of examination could favor conception in the months following its execution, precisely due to the “cleaning” action performed by the contrast medium inside the tubes.

Alternatives

The increasingly popular alternative is  sonohysterosalpingography , an ultrasound and non-radiographic test , which therefore has the advantage of not using radiation.

Compared to hysterosalpingography, this exam more faithfully reproduces any irregularities of the uterus and is therefore preferable for investigating the possible causes of recurrent miscarriages . On the other hand, however, it does not allow for the evaluation of tubal motility.

As always, therefore, the doctor will decide which type of test to prescribe depending on the individual situation.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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